Health reform could bring a crowd, some leaders say

With health reform now a certainty, some local health care leaders are bracing for a surge in waiting-room complaints as thousands of newly insured patients start showing up for medical care.

The Affordable Care Act mandates increased health coverage for the uninsured. In California, that means expanding the state’s Medi-Cal program and offering subsidized insurance plans on a newly created state-run exchange.

On the first day of 2014, more than 300,000 uninsured San Diego County residents are expected to qualify for coverage. Many health care experts say there simply will not be enough doctors to go around.

“We know that, for the Medi-Cal population, and for the newly insured, those folks are being dealt a false promise,” Mazer said. “They’re saying, ‘Here is your insurance, go find a doctor,’ but we know that even as things are today, current beneficiaries can’t find a doctor.”

Mazer added that cuts to physician reimbursement are likely to cut the already-anemic number of primary care doctors and specialists willing to accept Medi-Cal insurance, just at the wave of newly insured patients hits. He predicted that many of those who cannot find a doctor will end up going to the emergency room for care, just as many are already doing today.

“You’re going to complicate the care for the patients who currently have some access because you’re going to flood the market with more people with a Medi-Cal card and you’re not doing anything to improve the infrastructure,” Mazer said.

The doctor shortage has been documented by many publications, most recently the Annals of Family Medicine which published a study Nov. 20 that found an additional 52,000 more primary care doctors will be needed nationwide by 2025 to cope with the surge in demand.

But not everyone sees difficulty on the horizon. Gary Rotto, director of health policy for the Council of Community Clinics, which represents 16 neighborhood health centers in the region, said he believes that the wave of new patients will arrive gradually, making it more ridable.

“There will be an initial crunch, but we believe that we can work people into the system and provide the care that they need at our clinics,” Rotto said.

Whether it is devastating or not, the wave is coming.

According to the California Health Benefit Exchange, 2.6 million Californians will be eligible to purchase subsidized health insurance on the first day of 2014, and an additional 2.4 million will be newly eligible for full coverage through Medi-Cal.

The UCLA Center for Health Policy Research, based on a 2009 statewide health survey, estimates that roughly 18.7 percent of San Diego County residents — about 515,000 people — are uninsured.

Statewide, the study estimates that nearly 43 percent of uninsured Californians will qualify for Medi-Cal in 2014. That could mean 43 percent of local uninsured, or about 220,000 people, will join the Medi-Cal rolls as a result of health care reform. An additional 123,000 could be eligible to purchase care on the new insurance exchange at subsidized rates.